RCR statement on the Leng review and the future of Physician Assistants within our specialties
The introduction of Physician Associates (PAs) in the NHS has raised serious concerns amongst some of our members, including about restricting training opportunities for resident doctors, a lack of regulation and scope creep. However, in some areas – particularly Clinical Oncology – PAs are performing clearly defined functions that are supporting doctors, as valuable members of a multiprofessional team.
We welcome the publication of the Leng review and are hopeful that it can lead to a clearer way forward. We support several of the changes it has proposed – such as ensuring there’s a greater distinction between Physician Assistants and doctors, clearer scope, and the recognition that training of doctors is paramount.
Over time, we hope that a position will be reached where teams that include PAs consistently work safely and effectively, and that training opportunities for resident doctors are enhanced rather than compromised.
However, it is clear there is still work to be done, to define how PAs work with our specialties. We will play an active role in resolving these issues, through defining a clear scope of practice for PAs relating to our specialties.
Our position on PAs within Clinical Radiology and Clinical Oncology is as follows:
- We do not foresee any role for PAs in Diagnostic Radiology.
- We believe there could be a limited, tightly defined role for PAs to support doctors working in Interventional Radiology, with appropriate supervision.
- There is a role for PAs working in cancer MDTs within Clinical Oncology, alongside many other non-doctors. Like all other roles they should operate within a clear scope of practice.
- PAs should not be requesting any clinical imaging investigations. As Advanced PA roles are developed, there is potential for their practice to be extended to request non-ionising radiation investigations, within doctor-led teams and acting under appropriate supervision. We will keep closely involved with the development of Advanced PA roles as conversations progress.
Our next steps will be to:
- Establish two short-life working groups to define a clear, evidence-based scope of practice for PAs in Interventional Radiology and Clinical Oncology. Our priority will be making sure that PAs work safely and effectively, in tasks which support doctors and protect their training and development.
- Continue to influence NHS England’s forthcoming Medical Training Review, which we hope will address the drivers of a poor experience of specialty training. We understand this will be published in the autumn.
Dr Katharine Halliday, President of the Royal College of Radiologists, said:
“Extended roles for nurses, AHPs and Physician Assistants work best if embedded in a well-functioning team with clear roles, appropriate training and supervision for all. As doctors we are team leaders and must drive this positive way of working, valuing all colleagues who work with us for the benefit of patients.”
Dr Tom Roques, Vice-President for Clinical Oncology, said:
“Excellent cancer care is founded on good teamwork. All roles within that team need clear lines of accountability, appropriate supervision and scope of practice to be effective - for the benefit of all staff and particularly for patients. The Leng review helps clarify how we can move forward constructively."
Dr Rubab Batool and Dr David Johnston, Oncology Registrars’ Forum Co-Chairs, said:
"Clinical Oncology resident doctors work within multidisciplinary teams (MDTs), which are integral to both training and the delivery of safe patient care. It is essential for all members of an MDT to have clearly defined roles. We welcome the Leng Review report and support the RCR's stance on prioritising training opportunities for resident doctors."
Dr Aaron Taylor, Radiology Resident Doctors Forum Chair, said:
"In light of the consultant workforce shortage, expanding training numbers for resident doctors is essential. It is equally important to protect and maximise their training opportunities, which are already under strain. While the Leng Review suggests a limited role for PAs in supporting physicians, this must remain within a clearly defined scope that does not compromise resident doctors’ training."